The speech will be about what hindrances and facilitating factors can be observed in the process of developing integrated services for persons with severe mental illnesses. The limits of governmental authorities' abilities to make services providers to co-operate and practice evidence based methods are highlighted. Evidence exists that point to that an integrated approach is more efficient compared to separate service options. The examples are drawn from Sweden, a nation where services mainly are parts of the public sector.
Background: Beardslee's family intervention (FI), which is a family-based preventive method for children of mentally ill parents, has been implemented on a national level in Sweden. Material: Fourteen children and parents from nine families were interviewed about how the FI was for the children. Data were analysed by qualitative content analysis. Discussion: A central finding was children's sense of relief and release from worry because of more knowledge and openness about the parent's illness in the family. Conclusion: The results indicating relief for the children are encouraging.
Background: Beardslee's family intervention (FI) is a family-based intervention to prevent psychiatric problems for children of mentally ill parents. The parents' experiences are of importance in family-based interventions. Method: Twenty five parents were interviewed about their experiences of FI. Data were analysed by qualitative methods. Discussion: Confidence and security in the professionals and in FI as a method were prerequisites for initiating communication about the parents' mental illness with the children. Conclusions: FI provides a solid base for an alliance with the parents and might be a practicable method when parenthood and children are discussed with psychiatric patients.
Background Although shared decision-making (SDM) has been widely recommended in clinical guidelines, it is not implemented in practice. In early 2024, managers of a centre (home for care or residence, HVB) in Sweden decided to implement SDM. Researchers arranged an intensive course that included training in SDM, which was offered to all users, staff members and managers at the centre.
Aim To explore the experiences of users, staff members and managers when SDM was introduced at a centre for women suffering from mental illness.
Method and Results After introducing SDM, persons who had experience as users of mental health services conducted individual interviews with users, staff members and managers. The data were transcribed automatically during the video interviews. The data were analysed using thematic analysis, and the results represent three different aspects. Users: Previous experience is important, Attitudes to participation and What is needed for continuation. Staff: Ability to increase participation and SDM as an integrated way of working. Managers: Changes in the care atmosphere and Management during the introduction.
Relevance Research concerning people staying at HVBs is scarce, as is research on SDM concerning adults with severe mental illness. It is important to highlight the needs of this group, as participation today and in the future is an important and often overlooked aspect for these users.
This case study investigates the implementation of a free-choice market system in community mental health services using the example of day centres for people with psychiatric disabilities. It was conducted in a major city that was about to implement a free-choice market system due to a new legislation that made it feasible. Eighteen semi-structured interviews were conducted. Agents situated in different parts of the organization were interviewed one year before and two years after the free-choice system was launched in 2010. Data showed a top–down political process. A majority of the intentions of the legislation advocated individual autonomy as the market system's main purpose; only one concerned organizational efficiency. Data reflected, however, that financial efficiency dominated the agents' experiences of the implemented system. The twofold market purpose was clearly reflected in the interviews. Front-line staff hoped for improvements mainly for the users, whereas managers mainly focused on the market as a resource allocator.
Purpose: The purpose of this study was to describe mental health professionals' experiences of changes in attitudes towards, and knowledge about, users of mental health-care recovery and decisional participation in clinical practice after an educational intervention. Design/methodology/approach: Users of mental health care want to participate in decisions regarding their own mental health care. Shared decision-making as a method is coherent with recovery orientation in mental health services and results in better-informed patients and fewer conflicts regarding decisions. A qualitative intervention study was designed to evaluate changes in attitudes and knowledge about mental health recovery in Sweden. Nine participants were interviewed, and the data were analysed by content analysis. Findings: Three categories were generated from the analysis: Increased theoretical knowledge, changing attitudes about practical approaches and the significance of social factors in recovery. Originality/value: When shared decision-making is to be implemented in mental health, professionals need to gain knowledge about recovery and need to adopt changed roles as health professionals. Educational interventions therefore seem necessary if such changes are to happen.
The aim of this study is to provide a survey of systematic reviews that have evaluated the effects of psychosocial interventions for adult people with intellectual disabilities and/or an autistic syndrome with concurrent mental health problems. Reviews for inclusion were identified through searches of 10 electronic databases. The authors found that 3 out of 126 published reviews met the inclusion criteria for interventions, population, and being considered a systematic review. The results imply a weak scientific support for behavioral therapy, cognitive-behavioral therapy, and some forms of integrated care and support. However, the primary studies included in the reviews have several methodological shortcomings. The results suggest future research initiatives in the direction of more effectiveness studies of good quality and reproduction of high-quality systematic reviews.
As part of a Nordic multi-centre study investigating the life and care situation of community samples of schizophrenic patients the aim of the present part of the study was to examine the relationship between global subjective quality of life and objective life conditions, clinical characteristics including psychopathology and number of needs for care, subjective factors such as satisfaction with different life domains, social network, and self-esteem. A sample of 418 persons with schizophrenia from 10 sites was used. The results of a final multiple regression analysis, explaining 52.3% of the variance, showed that five subjective factors were significantly associated with global subjective quality of life, together with one objective indicator, to have a close friend. No clinical characteristics were associated with global subjective quality of life. The largest part of the variance was explained by satisfaction with health, 36.3% of the variance, and self-esteem, 7.3% of the variance. It is concluded that the actual relationship between objective life conditions and subjectively experienced quality of life still remains unclear. Furthermore, it seems obvious that personality related factors such as self-esteem, mastery and sense of autonomy also play a role in the appraisal of subjective quality of life, which implies that factors like these are important to consider in clinical and social interventions for patients with schizophrenia in order to improve quality of life for these persons.
COVID-19 shocked health and economic systems leaving millions of people without employment and safety nets. The pandemic disproportionately affects people with substance use disorders (SUDs) due to the collision between SUDs and COVID-19. Comorbidities and risk environments for SUDs are likely risk factors for COVID-19. The pandemic, in turn, diminishes resources that people with SUD need for their recovery and well-being. This article presents an interdisciplinary and international perspective on how COVID-19 and the related systemic shock impact on individuals with SUDs directly and indirectly. We highlight a need to understand SUDs as biopsychosocial disorders and use evidence-based policies to destigmatize SUDs. We recommend a suite of multi-sectorial actions and strategies to strengthen, modernize and complement addiction care systems which will become resilient and responsive to future systemic shocks similar to the COVID-19 pandemic.
